Healthcare Provider Details

I. General information

NPI: 1841110756
Provider Name (Legal Business Name): RENUEVA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WINTER HAVEN DR NW STE I
ALBUQUERQUE NM
87120-1746
US

IV. Provider business mailing address

6001 WINTER HAVEN DR NW STE I
ALBUQUERQUE NM
87120-1746
US

V. Phone/Fax

Practice location:
  • Phone: 505-934-5002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA GOLSON
Title or Position: OWNER
Credential: AGPCNP-BC
Phone: 505-934-5002